Acute lower extremity arterial thrombosis associated with nephrotic syndrome in adults: case series and literature review.

BACKGROUND: Nephrotic syndrome (NS) is a condition associated with hypercoagulability. Thromboembolic events are a well-recognized complication of NS. Venous thrombosis is well known, while arterial thrombosis, which is more severe, occurs less frequently and is mainly reported in children in the literature. The aim of this study was to understand these rare adult cases of NS associated with acute lower extremity arterial thrombosis and draw attention to them to prevent misdiagnosis and delayed treatment. METHODS: From January 2011 and October 2022, we conducted a retrospective study of patients with NS and arterial thrombosis. Their clinical manifestations, imaging characteristics, treatments and outcomes were analyzed and compared, and a literature review was performed. RESULTS: Nine adults with NS and acute lower limb arterial thrombosis were described. In seven of these patients, six had fresh thrombi that preceded the NS diagnosis, while one had a history of NS for 14 years and previously underwent an emergency thrombectomy. Three of the seven patients eventually underwent above-knee amputations, and the other four underwent arterial revascularization with satisfactory recovery of lower-extremity perfusion. In addition to the seven patients mentioned above, the other two received successful anticoagulant treatment, as the thrombosis was present only in the popliteal artery. CONCLUSION: Acute lower extremity arterial thrombosis is a rare but serious and potentially lethal complication in patients with NS, and early recognition and appropriate management are crucial for good patient outcomes.

Case report: Cement entrapped in the inferior vena cava filter after pedicle screw augmentation.

Background: Cement leakage into the inferior vena cava (IVC) is one of the most common complications associated with cement vertebroplasty, and can lead to potentially life-threatening complications such as pulmonary cement embolism (PCE). Implantation of an IVC filter is effective in the prevention of fatal pulmonary embolism. Here, we present an extremely rarely case of cement entrapped in an IVC filter after pedicle screw augmentation, and discuss all similar cases reported in the literature. Case presentation: A 70-year-old female presented with significant back and lower extremities pain and was unable to walk. MRI of the lumbar spine revealed an osteoporotic compression fracture of the L1-L3. She underwent cement-augmented pedicle screws implanted at the L1 and L3 vertebral bodies. A retrievable IVC filter was implanted due to the presence of calf vein thrombosis before cement vertebroplasty. Cement leaked into the IVC and was trapped by the filter, rendering the filter unretrievable using a conventional method. The asymptomatic patient received rivaroxaban 20 mg daily for anticoagulant postoperatively and lifelong anticoagulation was administered to prevent secondary IVC and cemented filter thrombosis. Methods: A literature search was conducted utilizing the PUBMED/MEDLINE using the following terms: "vertebroplasty," "complication," "bone cement," and "inferior vena cava (IVC)," or "inferior vena cava (IVC) filter." All relevant articles published in English or in other languages with English abstracts since 1962 were included. Results: A total of 36 articles were retrieved according to the search strategy. Only 6 out of these 36 studies contained information regarding the inferior vena cava filter and cement. Of the patients, 85.7% (36/42) reported in the literature whose gender was known were female and 14.3% were male. 28.5% (45/158) patients with pulmonary arterial and cardiovascular complications. Conclusion: Cement embolization occurring in the IVC filter is rare. Accurate knowledge about the lumbar vertebral venous anatomy and skillful operation during vertebral cementoplasty should be required in clinical practice.

Metformin protects against abdominal aortic aneurysm by Atg7-induced autophagy.

BACKGROUND: Abdominal aortic aneurysm (AAA) is a pathological dilation of the abdominal aorta. It is often asymptomatic, yet it has a high susceptibility to rupture. Our previous study showed that metformin protected against the pathophysiology of AAA by reducing the activation of the PI3K/AKT/mTOR pathway. OBJECTIVES: To investigate the potential involvement of the autophagy-related pathways in AAA and the ability of metformin to modulate these effects. MATERIAL AND METHODS: The expression of autophagy-related proteins was detected with western blot in patients with AAA. Angiotensin II (Ang-II) was also used to construct an AAA model in mice and in vascular smooth muscle cells (VSMCs). The expression of Atg7 and Atg4 was determined using western blot assay. The Atg7 expression was regulated by overexpressed plasmid, siRNA (small interfering RNA), or metformin, and cell proliferation, migration, apoptosis and autophagy caused by Ang-II were examined. RESULTS: Autophagy-related proteins were increased in patients with AAA. The Ang-II also induced the expression of Atg7, and metformin reversed this effect both in vivo and in vitro. The suppression of Atg7 inhibited cell proliferation and cell migration, and reduced cell apoptosis and autophagy, while the overexpression of Atg7 enhanced cell proliferation and migration, and induced cell apoptosis and autophagy. Furthermore, Atg7 regulated the expression of the autophagy-related protein in Ang-II treated VSMCs. The Atg7-mediated autophagy was also attenuated by metformin. CONCLUSIONS: Metformin reduced autophagy in AAA and this effect was mediated by Atg7, suggesting that Atg7 is a potential downstream effector of metformin in protecting against the pathophysiology of AAA.

Comparison of different embolic particles for superior rectal arterial embolization of chronic hemorrhoidal bleeding: gelfoam versus microparticle.

BACKGROUND: Whether different embolic particles with comparable diameter lead to similar beneficial effects in endovascular embolization of hemorrhoidal disease remains to be established. We sought to evaluate the efficacy and safety of different types of agents for superior rectal arterial embolization (SRAE) in patients with bleeding hemorrhoids. METHODS: Patients with recurrent episodes of internal hemorrhoidal bleeding and chronic anemia treated by SRAE in three tertiary hospitals between March 2017 and June 2020 were retrospectively evaluated. The patients were divided into two study groups based on the embolic materials: embolization with coils (2-3 mm) + gelfoam particles at 350-560 µm (Group A, n = 23), embolization with coils (2-3 mm) + microparticles at 300-500 µm (Group B, n = 18). The technical success, preliminary clinical efficacy (percentage of patients without hematochezia), postoperative complications and short-term follow-up outcomes were analysed. RESULTS: A total of 41 patients (27 males) with symptomatic hemorrhoids were included in the study, mean age was 47 ± 12 years (range 25-72). 39% (16) patients with grade II hemorrhoids while 61% (25) patients with grade III. The technical success rate of the embolization procedure was 100%, and the preliminary clinical efficacy (87.0% vs 88.9%) showed no significant difference between the 2 groups (p = 0.098). No patients reported post-procedural and short-term serious complications, such as infection, intestinal ischemia or massive hemorrhage during the follow-up period (range 6-15 months). CONCLUSIONS: Both gelfoam particles and microparticles with comparable diameter in the endovascular treatment of hemorrhoidal bleeding demonstrated similarly good short-term efficacy and safety profile.

Diagnostic value of miR-92a in asymptomatic carotid artery stenosis patients and its ability to predict cerebrovascular events.

BACKGROUND: Early diagnosis of asymptomatic carotid artery stenosis (ACAS) is important to prevent the incidence of cerebrovascular events. This study aimed to investigate the circulating expression of microRNA-92a (miR-92a) in ACAS patients and evaluate its diagnostic value for ACAS and predictive value for cerebrovascular events. METHODS: Circulating expression of miR-92a was measured using quantitative real-time PCR. Chi-square test was used to analyze the association of miR-92a with ACAS patients' clinical characteristics. A receiver operating characteristic (ROC) was used to evaluate the diagnostic value of miR-92a, and the Kaplan-Meier method and Cox regression analysis were used to assess the predictive value of miR-92a for cerebrovascular events. RESULTS: Serum expression of miR-92a was higher in ACAS patients than that in the healthy controls (P <  0.001), and associated with patients' degree of carotid stenosis (P = 0.013). The elevated miR-92a expression could distinguish ACAS patients from healthy individual, and was an independent predictive factor for the occurrence of cerebrovascular events (P = 0.015). CONCLUSION: The data from this study indicated that circulating increased miR-92a may serve as a noninvasive diagnostic biomarker for ACAS and a potential risk factor for the future onset of cerebrovascular events.